Wednesday, August 24, 2011

Complaints About Insurance

There has been a lot of talk in the media over the last few years about health insurance companies. Some perspectives offer up health insurance companies as the savior of our bloated health care industry. The insurance companies help hold down costs, innovate cost-saving measures, and drive quality. The news from other quarters suggested that the bloated corporate structures of these very same companies restrain innovation, ration care, and divert money from patient care.

The news also gives doctors a similar treatment. We can simultaneously read articles deriding one hospital that chargers $80 for a tablet of acetaminophen while another article talks about the shortage of primary care doctors driven, in part, because the field doesn't pay enough for them to be able to afford their own medical education. 

I've recently had an experience with an insurance company that really just frosted me. I could rant for some time about what happened. Suffice it to say, sending a claim to this particular insurance company is a bit like throwing a nano-particle into the ocean and hoping to retrieve the particle again ten years later by catching it in a coffee filter. The company engaged in a game of lost-and found with the billing forms. When they reappeared they were diverted to an outside processing company which promised to pay me faster if I accepted less money. When I declined the billing forms were lost again, only to be found after several angry phone calls from myself and my patient.

The final straw was when the patient complained to their employer about the low quality of the health insurance. The company brought the concerns back to the insurance company, which in turn called me asking if I'd be willing to become a provider in their network. I was offered a contracted rate that was significantly below any other insurance company in the area along with an 'array' of benefits including a coupon for discount diet products from a national diet company chain.

That just really frosted me. The lost forms, the promise of 'expidited' payment in return for accepting less than half my normal fee, and then there is the coupon. Really?

So please accept into consideration my experience with this particular health insurance company. It is part of the puzzle of health care reform. It's an important part. I offer you the letter that I sent to this nameless insurance company so you can learn a little bit more of my experience of dealing with insurance.

Dear (Health Insurance Company Provider Relations Specialist),
I received your voice mail yesterday. This is actually the second phone call I've gotten from (health insurance company) in the past two weeks--both have asked me if I was interested in becoming a contracted provider with (health insurance company).
In 2010 I declined a contract with (health insurance company) because I found the reimbursement rate for contracted psychologists to be unreasonably low. The quoted figure, $70 per 90806 service, is lower than any other insurance company that I am contracted with. In addition it is less than half my standard fee. 
To put the reimbursement rate that (health insurance company) offers contracted psychologists in context, I pay more than that rate to my hair stylist for a haircut, I pay more money to a licensed massage therapist for a massage, and I pay more money for that for an oil change and regular service at my automobile dealer. I pay close to that amount to fill up my moderate sized vehicle with gas. A reimbursement rate  of $70 isn't sufficient to keep the lights on in my office, let alone compensate me for the significant investment I've made in my education or the significant amount of skills I provide my patients.
Additionally, I've encountered nothing but difficulty with out-of-network business I have had with (insurance company). Billing forms are lost and misdirected by your company, I've encountered scores of unhelpful, knowledgeable, and  rude provider relations representatives, and received constant requests to receive a lower rate of reimbursement in return for "speedy" response to my billing invoices.
The most recent contract I've received from (insurance company) last week came with a list of "discounts" offered to contracted providers. I found that particularly insulting. I'm not interested in receiving coupons for diet centers, discount eye glasses, or any other services. I'm interested in being reasonably compensated for my time, experience, and training. I'm interested in having my billing forms processed promptly and my concerns addressed rapidly. 
I again decline becoming a contracted provider with (health insurance company). It simply does not make good business sense for me to enter into a contract with your company.
Dr. Jason Evan Mihalko

1 comment:

  1. Sadly, that seems to be a more common thing. I personally think the insurance companies are one of the biggest problems with the state of health care in this country. Another contender is big pharmaceutical companies. Insurance companies do their best to deny every claim they can manage - it's really disheartening to hear the games they play to try to coerce you into signing a contract with them. When I see my insurance statements come back with the amount billed versus the contracted amount they actually pay to my providers, it makes me ill. I have no idea how any medical practice stays in business with the low amounts the insurance companies pay...